sodium chloride (iv/oral)

High Alert

IV: Hydration and provision of NaCl in deficiency states.
Maintenance of fluid and electrolyte status in situations in which losses may be excessive (excess diuresis or severe salt restriction).
0.45% ("half-normal saline") solution is most commonly used for hydration and the treatment of hyperosmolar diabetes (hypotonic).
0.9% ("normal saline") solution is used for:
- Replacement,
- Treatment of metabolic alkalosis,
- A priming fluid for hemodialysis,
- To begin and end blood transfusions.
Small volumes of 0.9% NaCl (preservative-free or bacteriostatic) are used to reconstitute or dilute other medications.
Hypertonic solution (3%, 5%) may be required in situations in which rapid replacement of sodium is necessary:
- Hyponatremia,
- Hypochloremia,
- Renal failure,
- Heart failure.
PO: Prevention of or management of volume depletion due to salt restriction or heat prostration when excessive sweating occurs during exposures to high temperatures.

Irrigating Solutions

0.9% and 0.45% may be used as irrigating solutions.

Concentrated sodium chloride

Used as an additive to parenteral fluid therapy in very specific situations.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypertonic (3%, 5%) solutions should not be used in patients with elevated, slightly decreased, or normal serum sodium;
Fluid retention or hypernatremia.

Use Cautiously in:

Patients prone to metabolic, acid-base, or fluid and electrolyte abnormalities, including:
- geriatric patients,
- those with nasogastric suctioning,
- vomiting,
- diarrhea,
- diuretic therapy,
- glucocorticoid therapy,
- fistulas,
- HF,
- severe renal failure,
- severe liver diseases (additional electrolytes may be required);
Pedi: NaCl preserved with benzyl alcohol should not be used in neonates;
Inadequate hydration (water and other electrolytes must be replaced).

Adv. Reactions/Side Effects ⬆ ⬇

Seen primarily during PO and IV use

CV: HF, PULMONARY EDEMA, edema

F and E: hypernatremia, hypervolemia, hypokalemia

Local: IVextravasation, irritation at IV site

Interactions ⬆ ⬇

Drug-drug:

Excessive amounts of NaCl may partially antagonize the effects of antihypertensives.
Use with corticosteroids may result in excess sodium retention.

Availability ⬆ ⬇

(Generic available)

IV solutions: 0.45%; 0.9%; 3%; 5%
Diluents: 0.9%
Concentrate for dilution: 14.6%; 23.4%
Tablets: 650 mg^OTC
In combination with: potassium (Slo-Salt-K), dextrose, electrolytes.

Route/Dosage ⬆ ⬇

IV (Adults ): 0.9% NaCl (isotonic): 1 L (contains 150 mEq sodium/L), rate and amount determined by condition being treated. 0.45% NaCl (hypotonic): 1–2 L (contains 75 mEq sodium/L), rate and amount determined by condition being treated. 3%, 5% NaCl (hypertonic): 100 mL over 1 hr (3% contains 50 mEq sodium per 100 mL; 5% contains 83.3 mEq sodium per 100 mL).
PO (Adults ): 1–2 g 3 times daily.
PO IV (Children and Infants): Maintenance sodium requirements: 3–4 mEq/kg/day (maximum: 150 mEq/day).
PO IV (Neonates ): Maintenance sodium requirements: 1–4 mEq/kg/day.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Sodium is a major cation in extracellular fluid and helps maintain water distribution, fluid and electrolyte balance, acid-base equilibrium, and osmotic pressure.
Chloride is the major anion in extracellular fluid and is involved in maintaining acid-base balance. Solutions of NaCl resemble extracellular fluid.
Reduces corneal edema by an osmotic effect.

Therapeutic effects:

IV: PO: Replacement in deficiency states and maintenance of homeostasis.

Classifications ⬆ ⬇

Therapeutic Classification: mineral and electrolyte replacements/supplements

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration. Replacement solutions of NaCl are administered IV only.

Distribution: Rapidly and widely distributed.

Metabolism/Excretion: Excreted primarily by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(various clinical effects‡)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown
IV	rapid (min)	end of infusion	unknown

‡PO, IV = electrolyte effects.

Patient/Family Teaching ⬆ ⬇

Explain to patient the purpose of the infusion.
Advise patients at risk for dehydration due to exposure to extreme temperatures when and how to take NaCL tablets. Inform patients that undigested tablets may be passed in the stool; oral electrolyte solutions are preferable.

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Indications ⬇